ABO血型不合的异基因造血干细胞移植对造血重建的影响  

The effect of ABO-incompatible allogeneic hematopoietic stem cell transplantation on hematopoietic reconstitution

作　　者：谭金哲[1] 匡紫微 秦莉[1] 

机构地区：[1]四川大学华西医院实验医学科,四川成都610041

出　　处：《中国输血杂志》2017年第2期139-142,共4页Chinese Journal of Blood Transfusion

摘　　要：目的回顾性分析异基因造血干细胞移植(allo-HSCT)对患者造血功能重建的影响。方法选取2011-2015年间于四川大学华西医院血液科行异基因造血干细胞移植术的患者105例,血型相合移植53例,血型不合移植52例,其中ABO主侧不合20例,ABO次侧不合24例,ABO主次侧不合8例,统计移植后3个月内患者红细胞悬液和血小板的输注量,以及粒系和巨核系植活时间,P<0.05提示有统计学意义。结果以ABO血型是否完全相合分组采用Wilcoxon秩和检验,发现粒系植活时间的差异有统计学意义(Z=-1.990,P<0.05)。以年龄、性别分组采用Wilcoxon秩和检验进行比较时,各观察指标均无统计学差异(Z值在-0.036^-1.072,P>0.05)。以不同血液疾病类型采用多组间Kruskal-Wallis进行比较分析发现,各观察指标均无统计学差异(χ~2值在0.011-3.392,P>0.05)。对ABO血型主侧不合、次侧不合以及主次侧均不合的患者进行多组间Kruskal-Wallis分析,发现粒系植活时间、巨核系植活时间以及3个月内红细胞悬液输注量的差异均存在统计学意义(P均<0.05),采用Kruskal-Wallis单因素分析进一步进行两两比较,发现ABO血型主侧不合组与次侧不合组之间在粒系植活时间、巨核系植活时间以及3个月内红细胞悬液输注量上,均存在统计学差异(P均<0.05)。发现ABO血型主侧不合组与主次侧均不合组之间在巨核系植活时间存在统计学差异(P<0.05),其余组之间不具有统计学意义。结论 ABO血型不合的移植在粒系的植活时间上比ABO血型相合的延迟。ABO血型主侧不合的移植在粒系植活时间、巨核系植活时间以及红系恢复上比ABO血型次侧不合的延迟。ABO血型主次侧不合的移植在巨核系植活时间比ABO血型主侧不合的延迟。Objective To perform a retrospective analysis to discuss the effect of ABO-incompatible allogenetic hematological stem cell transplantation（ allo-HSCT） on the function of the patient＇s hematopoietic reconstitution. Methods In this study,105 consecutive patients who were treated with allo-HSCT from January 2011 to December 2015 were studied. Among them,53 patients were transplanted with compatible blood types. Meanwhile,52 patients transplanted with incompatible blood types consisted of cases of major ABO-incompatibility（ n = 20）,minor ABO-incompatibility（ n = 24）,and major and minor ABO-incompatibility（ n = 8）. Hematopoietic reconstitution,including the volume of red blood suspension and platelet transfused,and the recovery time of granulocytic and megakaryocytic series in these patients,was analyzed within 3 months.P〈0. 05 demonstrates the results that were statistically significant. Results The time of granulocytic reconstitution recovery were statistically different between the ABO-compatible and incompatible cases,by the methods of Wilcoxon rank sum test（ Z=-1. 990,P= 0. 023）. Wilcoxon rank sum test was also applied to analyze hematopoietic reconstitution in different age and gender groups,but no statistical differences were observed（ P〉0. 05）. Among five types of blood diseases,the observed indexes were found to have no statistical differences（ P〉0. 05） using Kruskal-Wallis analysis. The time of granulocytic and megakaryocytic reconstitution recovery and units of RBCs transfused were different among major ABO-incompatible,minor ABO-compatible,and both major and minor ABO-incompatible cases within 3 months,by the methods of Kruskal-Wallis test（ χ^2 values were 8. 660,10. 473 and 9. 514 respectively,P values were 0. 013,0. 005 and 0. 009 respectively）. Using Kruskal-Wallis ANOVA analysis for further pairwise comparison,statistical differences were found in terms of the time of granulocytic and megakaryocytic reconstitution recovery,and the units of RBCs transfused withi

关 键 词：异基因造血干细胞移植 ABO血型不合 造血重建 

分 类 号：R457.11[医药卫生—治疗学] R457.7[医药卫生—临床医学]